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Design

The Jackson Heart Study (JHS) is a single-site prospective epidemiologic investigation of cardiovascular disease (CVD) among African-Americans from the Jackson, Mississippi metropolitan area. This study represents an expansion of one of the study sites of the Atherosclerosis Risk in Communities (ARIC) Study which included four geographically diverse communities in the U.S. (northwestern suburbs of Minneapolis, Minnesota; Washington County, Maryland; Forysth County, North Carolina; and the city of Jackson, Mississippi).

The ARIC Study included a comprehensive baseline examination (1987-1989) and three subsequent follow-up examinations occurring at approximately three-year intervals (1990-1992, 1993-1995, and 1996-1999). A total of 15,792 individuals between 45 and 64 years of age were initially examined and 3,732 were from the Jackson ARIC Cohort . Participants have been followed for CVD events and will continue to be followed for several additional years.

Prior to the examination, a series of community meetings and focus groups were held and a survey was conducted to identify ways to enhance participation in the initial and subsequent examinations and ways to strengthen awareness of CVD prevention. The JHS plans to include up to 6,500 African-American men and women between the ages of 35 and 84 and will invite all previous ARIC participants (approximately 59 to 78 years of age in 2000) along with younger and older men and women from a larger geographic area. Participants will be randomly selected in order to be representative of African-American residents of Jackson, Mississippi. Family members will be included in order to permit future studies of familial and genetic contributions to CVD. The JHS will be the largest investigation of CVD that has been undertaken in an African-American population.

The initial examination phase of the study began in the fall of 2000 and will take approximately three years to complete. An extensive examination will include a series of questionnaires (dealing with lifestyle habits, medical history, medications, social and cultural factors), physical assessments (height, weight, body size, blood pressure, electrocardiogram, ultrasound measurements of the heart and arteries in the neck, and lung function) and laboratory measurements (cholesterol and other lipids, glucose, indicators related to clotting of the blood, among others).

The information collected in this study include both conventional risk factors and new or emerging factors that may be related to CVD. Some of the newer areas of focus include early indicators of disease, genetics, socio-cultural influences such as socioeconomic status and discrimination, and physiological relations between common disorders such as high blood pressure, obesity and diabetes and their influence on CVD.

The JHS is sponsored by the National Heart, Lung, and Blood Institute (NHLBI) and the National Center on Minority Health and Health Disparities (NCMHD) at the National Institutes of Health (NIH). It is a partnership between NHLBI, NCMHD and three local institutions: Jackson State University, Tougaloo College, and the University of Mississippi Medical Center.

Jackson State University has established a Coordinating Center where all data collected during the study is managed, analysis of the data is performed, and community involvement is coordinated. Tougaloo College has established an Undergraduate Training Center where selected students are given the opportunity to take course work in public health and epidemiology and gain practical experience in health research to help prepare them for potential careers in these fields. The University of Mississippi Medical Center has established an Exam Center which is responsible for recruiting participants and conducting the examinations.

The NHLBI has established a field site in Jackson, Mississippi to provide scientific investigators and support staff similar to those associated with the Framingham Heart Study and Honolulu Heart Program, two other long-term successful single-site studies of CVD. The NHLBI and JHS investigators from these institutions work closely together and look forward to collaborating with scientists from other institutions in conducting and expanding the research opportunities associated with the JHS.

Rationale

Despite encouraging declines over the past three decades, CVD remains the number one cause of death in the U.S. A number of risk factors for coronary heart disease (CHD) and stroke have been identified; however, relatively few population-based studies have examined CVD in a large group of African-Americans. Existing evidence indicates that death rates for CVD in the U.S. are considerably higher among African-Americans. CVD death rates in Mississippi are the highest in the nation and particularly high among African-Americans. Furthermore, between 1980 and 1995, the decline in CVD death rates has been the slowest among African-American men and women in Mississippi relative to other groups in the state and nation.

Objectives

The primary objective of the JHS is to investigate the causes of CVD in African-Americans to learn how to best prevent this group of diseases in the future. More specific objectives include:

      (1) Determine the roles of cardiovascular risk factors such as obesity, dyslipidemia, insulin resistance, and blood pressure, in the development and progression of cardiovascular disease (CVD), with emphasis on hypertension-related disease (left ventricular hypertrophy, congestive heart failure, coronary heart disease, stroke and renovascular disease).

      (2) Identify factors related to the development of cardiovascular risk factors, such as obesity, hypertension, dyslipidemia, and insulin resistance.

      (3) Determine the roles of sociocultural factors, such as stress, racism and discrimination, and coping strategies, in the development of CVD and associated risk factors.

      (4) Define the role of familial or hereditary factors, specific genetic variants, and gene by environment interactions in the development of CVD and associated risk factors.

      (5) Identify novel risk factors for the development of CVD.

      (1) Expand minority investigator and community participation in CVD epidemiology research by building research capabilities at minority institutions and developing partnerships with experienced institutions.

      (2) Expand minority training opportunities in CVD epidemiology by attracting minority students to careers in public health and epidemiology and providing research experience through the Jackson Heart Study.

      (3) Apply strategies for improving minority participation in medical research by developing partnerships between the community and research institutions.

      (4) Provide health information to the African American community regarding risk factors for CVD, based on JHS findings.

      (5) Expand the overall national research effort on cardiovascular disease in African Americans by stimulating interest in this area and encouraging ancillary studies.

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